The course of language functions after temporal lobe epilepsy surgery: a prospective study
The course of language functions after temporal lobe epilepsy surgery: a prospective study
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DOI：
10.1111/ene.13113
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发表时间：
2016-12-01
影响因子：
5.1
通讯作者：
Villani, F.
中科院分区：
文献类型：
--
作者：
Giovagnoli, A. R.;Parente, A.;Villani, F.
背景和目的语言优势半球的前颞叶切除术（ATL）会损害命名。这项前瞻性研究探讨了手术前到手术后的不同语言成分的过程中，澄清哪些变化是相关的短期和长期outcomeoflanguage.Methods耐药颞叶癫痫（TLE）患者进行了评估，使用令牌，波士顿和单词流畅性测试评估句子的理解和单词的视觉，结果共106例患者在ATL治疗前、治疗后6个月、1年和2年接受评估; 60例患者在5年后接受评估，38例对照者在基线时接受评估。左侧和右侧TLE患者的癫痫发作结局相似。手术前，左右侧TLE患者的命名和单词流畅性受损，而句子理解正常。左或右ATL后，单词流畅性逐步改善，命名显示左ATL后早期恶化和晚期改善，右ATL后逐步改善，句子理解没有变化。在5年随访时，左侧和右侧TLE患者的命名改善分别为31%和71%，具有临床意义。术前命名，ATL偏侧性，学校教育，术后癫痫发作频率和抗癫痫药物的数量预测术后命名。结论左侧或右侧颞叶癫痫可以损害单词发现，但不是句子理解。ATL后，词的发现可能会改善很长一段时间，这取决于TLE的偏侧性，癫痫发作控制和心理储备。这些发现可以在治疗前澄清预后。
Background and purpose Anterior temporal lobectomy (ATL) within the language-dominant hemisphere can impair naming. This prospective study examined the pre-operative to post-operative course of different language components, clarifying which changes are relevant within the short-term and long-term outcome of language.Methods Patients with drug-resistant temporal lobe epilepsy (TLE) were evaluated using the Token, Boston Naming and Word Fluency tests assessing sentence comprehension and word-finding on visual, semantic or phonemic cues.Results A total of 106 patients were evaluated before and 6 months, 1 and 2 years after ATL; 60 patients were also evaluated after 5 years and 38 controls were assessed at baseline. Seizure outcome was comparable between the left and right TLE patients. Before surgery, naming and word fluency were impaired in the left and right TLE patients, whereas sentence comprehension was normal. After left or right ATL, word fluency progressively improved, naming showed early worsening and late improvement after left ATL and progressive improvement after right ATL, and sentence comprehension did not change. At the 5-year follow-up, naming improvement was clinically significant in 31% and 71% of the left and right TLE patients, respectively. Pre-operative naming, ATL laterality, schooling, and post-operative seizure frequency and number of antiepileptic drugs predicted post-operative naming. Pre-operative word fluency and schooling predicted post-operative word fluency.Conclusions Left or right TLE can impair word-finding but not sentence comprehension. After ATL, word-finding may improve for a long time, depending on TLE laterality, seizure control and mental reserve. These findings may clarify prognosis prior to treatment.